|
HC EYE PARACENTESIS W/RELEASE AQU
|
Facility
|
IP
|
$9,492.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
900501304
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,898.40 |
| Max. Negotiated Rate |
$8,542.80 |
| Rate for Payer: Adventist Health Commercial |
$1,898.40
|
| Rate for Payer: Cash Price |
$5,220.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,593.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,796.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,796.80
|
| Rate for Payer: Galaxy Health WC |
$8,068.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,695.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,542.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,331.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,616.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,875.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,898.40
|
| Rate for Payer: Multiplan Commercial |
$7,119.00
|
| Rate for Payer: Networks By Design Commercial |
$6,169.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,068.20
|
|
|
HC EYE PARACENTESIS W/RELEASE AQU
|
Facility
|
OP
|
$9,492.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
900501304
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.26 |
| Max. Negotiated Rate |
$8,542.80 |
| Rate for Payer: Adventist Health Commercial |
$1,898.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,617.28
|
| Rate for Payer: Cash Price |
$5,220.60
|
| Rate for Payer: Cash Price |
$5,220.60
|
| Rate for Payer: Cash Price |
$5,220.60
|
| Rate for Payer: Cash Price |
$5,220.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,593.60
|
| Rate for Payer: Cigna of CA HMO |
$6,074.88
|
| Rate for Payer: Cigna of CA PPO |
$7,024.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,897.90
|
| Rate for Payer: Galaxy Health WC |
$8,068.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,695.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,542.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,752.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: InnovAge PACE Commercial |
$4,346.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,331.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,897.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,898.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,883.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,883.19
|
| Rate for Payer: Multiplan Commercial |
$7,119.00
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$6,169.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Commercial |
$8,068.20
|
| Rate for Payer: Prime Health Services Medicare |
$3,071.77
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,187.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,695.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,746.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,746.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,746.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,746.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,897.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC EYE PARACENTESIS W/RML VITREOU
|
Facility
|
OP
|
$10,888.00
|
|
|
Service Code
|
CPT 65810
|
| Hospital Charge Code |
900501528
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$9,799.20 |
| Rate for Payer: Adventist Health Commercial |
$2,177.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,617.28
|
| Rate for Payer: Cash Price |
$5,988.40
|
| Rate for Payer: Cash Price |
$5,988.40
|
| Rate for Payer: Cash Price |
$5,988.40
|
| Rate for Payer: Cash Price |
$5,988.40
|
| Rate for Payer: Central Health Plan Commercial |
$8,710.40
|
| Rate for Payer: Cigna of CA HMO |
$6,968.32
|
| Rate for Payer: Cigna of CA PPO |
$8,057.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,897.90
|
| Rate for Payer: Galaxy Health WC |
$9,254.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,532.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,799.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,752.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: InnovAge PACE Commercial |
$4,346.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,262.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,897.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,177.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,883.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,883.19
|
| Rate for Payer: Multiplan Commercial |
$8,166.00
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$7,077.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Commercial |
$9,254.80
|
| Rate for Payer: Prime Health Services Medicare |
$3,071.77
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,187.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,532.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,444.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,444.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,444.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,897.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC EYE PARACENTESIS W/RML VITREOU
|
Facility
|
IP
|
$10,888.00
|
|
|
Service Code
|
CPT 65810
|
| Hospital Charge Code |
900501528
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,177.60 |
| Max. Negotiated Rate |
$9,799.20 |
| Rate for Payer: Adventist Health Commercial |
$2,177.60
|
| Rate for Payer: Cash Price |
$5,988.40
|
| Rate for Payer: Central Health Plan Commercial |
$8,710.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,355.20
|
| Rate for Payer: Galaxy Health WC |
$9,254.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,532.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,799.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,262.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,148.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,739.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,177.60
|
| Rate for Payer: Multiplan Commercial |
$8,166.00
|
| Rate for Payer: Networks By Design Commercial |
$7,077.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,254.80
|
|
|
HC EYE SERVICE ORPROCEDURE
|
Facility
|
IP
|
$369.00
|
|
|
Service Code
|
CPT 92499
|
| Hospital Charge Code |
900501542
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.80 |
| Max. Negotiated Rate |
$332.10 |
| Rate for Payer: Adventist Health Commercial |
$73.80
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Central Health Plan Commercial |
$295.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.60
|
| Rate for Payer: EPIC Health Plan Senior |
$147.60
|
| Rate for Payer: Galaxy Health WC |
$313.65
|
| Rate for Payer: Global Benefits Group Commercial |
$221.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$332.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.80
|
| Rate for Payer: Multiplan Commercial |
$276.75
|
| Rate for Payer: Networks By Design Commercial |
$239.85
|
| Rate for Payer: Prime Health Services Commercial |
$313.65
|
|
|
HC EYE SERVICE ORPROCEDURE
|
Facility
|
OP
|
$369.00
|
|
|
Service Code
|
CPT 92499
|
| Hospital Charge Code |
900501542
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$31.12 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$73.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$49.59
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Central Health Plan Commercial |
$295.20
|
| Rate for Payer: Cigna of CA HMO |
$236.16
|
| Rate for Payer: Cigna of CA PPO |
$273.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.01
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: Galaxy Health WC |
$313.65
|
| Rate for Payer: Global Benefits Group Commercial |
$221.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$332.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$51.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: InnovAge PACE Commercial |
$46.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.70
|
| Rate for Payer: Multiplan Commercial |
$276.75
|
| Rate for Payer: Multiplan WC |
$49.59
|
| Rate for Payer: Networks By Design Commercial |
$239.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$31.12
|
| Rate for Payer: Preferred Health Network WC |
$50.60
|
| Rate for Payer: Prime Health Services Commercial |
$313.65
|
| Rate for Payer: Prime Health Services Medicare |
$32.99
|
| Rate for Payer: Prime Health Services WC |
$49.08
|
| Rate for Payer: Riverside University Health System MISP |
$34.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$221.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$184.50
|
| Rate for Payer: United Healthcare All Other HMO |
$184.50
|
| Rate for Payer: United Healthcare HMO Rider |
$184.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$184.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$31.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC FACIAL BONES COMPLETE
|
Facility
|
IP
|
$1,695.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
909001101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$339.00 |
| Max. Negotiated Rate |
$1,525.50 |
| Rate for Payer: Adventist Health Commercial |
$339.00
|
| Rate for Payer: Cash Price |
$932.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,356.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.00
|
| Rate for Payer: EPIC Health Plan Senior |
$678.00
|
| Rate for Payer: Galaxy Health WC |
$1,440.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,525.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,130.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$645.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,049.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.00
|
| Rate for Payer: Multiplan Commercial |
$1,271.25
|
| Rate for Payer: Networks By Design Commercial |
$1,101.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,440.75
|
|
|
HC FACIAL BONES COMPLETE
|
Facility
|
OP
|
$1,695.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
909001101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.25 |
| Max. Negotiated Rate |
$1,525.50 |
| Rate for Payer: Adventist Health Commercial |
$339.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,029.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$163.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,028.87
|
| Rate for Payer: Blue Shield of California EPN |
$672.91
|
| Rate for Payer: Cash Price |
$932.25
|
| Rate for Payer: Cash Price |
$932.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,356.00
|
| Rate for Payer: Cigna of CA HMO |
$1,084.80
|
| Rate for Payer: Cigna of CA PPO |
$1,254.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,440.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,525.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$64.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,130.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,271.25
|
| Rate for Payer: Networks By Design Commercial |
$1,101.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,440.75
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,017.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,017.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC FACIAL BONES LIMITED
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
909001102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.15 |
| Max. Negotiated Rate |
$1,019.70 |
| Rate for Payer: Adventist Health Commercial |
$226.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$688.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.15
|
| Rate for Payer: Blue Shield of California Commercial |
$687.73
|
| Rate for Payer: Blue Shield of California EPN |
$449.80
|
| Rate for Payer: Cash Price |
$623.15
|
| Rate for Payer: Cash Price |
$623.15
|
| Rate for Payer: Central Health Plan Commercial |
$906.40
|
| Rate for Payer: Cigna of CA HMO |
$725.12
|
| Rate for Payer: Cigna of CA PPO |
$838.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$963.05
|
| Rate for Payer: Global Benefits Group Commercial |
$679.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,019.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$755.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$849.75
|
| Rate for Payer: Networks By Design Commercial |
$736.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$963.05
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$679.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$679.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC FACIAL BONES LIMITED
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
909001102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$226.60 |
| Max. Negotiated Rate |
$1,019.70 |
| Rate for Payer: Adventist Health Commercial |
$226.60
|
| Rate for Payer: Cash Price |
$623.15
|
| Rate for Payer: Central Health Plan Commercial |
$906.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.20
|
| Rate for Payer: EPIC Health Plan Senior |
$453.20
|
| Rate for Payer: Galaxy Health WC |
$963.05
|
| Rate for Payer: Global Benefits Group Commercial |
$679.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,019.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$755.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$431.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$701.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.60
|
| Rate for Payer: Multiplan Commercial |
$849.75
|
| Rate for Payer: Networks By Design Commercial |
$736.45
|
| Rate for Payer: Prime Health Services Commercial |
$963.05
|
|
|
HC FACILITY CHARGE
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
CPT 99999
|
| Hospital Charge Code |
910400998
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$583.20 |
| Rate for Payer: Adventist Health Commercial |
$129.60
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Central Health Plan Commercial |
$518.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.20
|
| Rate for Payer: EPIC Health Plan Senior |
$259.20
|
| Rate for Payer: Galaxy Health WC |
$550.80
|
| Rate for Payer: Global Benefits Group Commercial |
$388.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$583.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$432.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$401.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.60
|
| Rate for Payer: Multiplan Commercial |
$486.00
|
| Rate for Payer: Networks By Design Commercial |
$421.20
|
| Rate for Payer: Prime Health Services Commercial |
$550.80
|
|
|
HC FACILITY CHARGE
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
CPT 99999
|
| Hospital Charge Code |
910400998
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$583.20 |
| Rate for Payer: Adventist Health Commercial |
$129.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$393.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$550.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$356.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$486.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$313.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$380.57
|
| Rate for Payer: Blue Shield of California Commercial |
$395.93
|
| Rate for Payer: Blue Shield of California EPN |
$258.55
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Central Health Plan Commercial |
$518.40
|
| Rate for Payer: Cigna of CA HMO |
$414.72
|
| Rate for Payer: Cigna of CA PPO |
$479.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$550.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$550.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$550.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.20
|
| Rate for Payer: EPIC Health Plan Senior |
$259.20
|
| Rate for Payer: Galaxy Health WC |
$550.80
|
| Rate for Payer: Global Benefits Group Commercial |
$388.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$583.20
|
| Rate for Payer: InnovAge PACE Commercial |
$324.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$432.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$401.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$453.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$453.60
|
| Rate for Payer: Multiplan Commercial |
$486.00
|
| Rate for Payer: Networks By Design Commercial |
$421.20
|
| Rate for Payer: Prime Health Services Commercial |
$550.80
|
| Rate for Payer: Riverside University Health System MISP |
$259.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$388.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$388.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.00
|
| Rate for Payer: United Healthcare All Other HMO |
$324.00
|
| Rate for Payer: United Healthcare HMO Rider |
$324.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$324.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$550.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$550.80
|
| Rate for Payer: Vantage Medical Group Senior |
$550.80
|
|
|
HC FACTOR II (2) ASSAY
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
900910075
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23.60
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
|
|
HC FACTOR II (2) ASSAY
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
900910075
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$94.48 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.17
|
| Rate for Payer: Blue Shield of California Commercial |
$35.81
|
| Rate for Payer: Blue Shield of California EPN |
$23.42
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: Cigna of CA HMO |
$37.76
|
| Rate for Payer: Cigna of CA PPO |
$43.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.52
|
| Rate for Payer: EPIC Health Plan Senior |
$12.98
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.98
|
| Rate for Payer: InnovAge PACE Commercial |
$19.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.39
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.98
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Prime Health Services Medicare |
$13.76
|
| Rate for Payer: Riverside University Health System MISP |
$14.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.51
|
| Rate for Payer: United Healthcare All Other HMO |
$10.51
|
| Rate for Payer: United Healthcare HMO Rider |
$10.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Vantage Medical Group Senior |
$12.98
|
|
|
HC FACTOR IX PTC
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
900910029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$19.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.11
|
| Rate for Payer: Blue Shield of California Commercial |
$101.98
|
| Rate for Payer: Blue Shield of California EPN |
$66.70
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Central Health Plan Commercial |
$134.40
|
| Rate for Payer: Cigna of CA HMO |
$107.52
|
| Rate for Payer: Cigna of CA PPO |
$124.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.70
|
| Rate for Payer: EPIC Health Plan Senior |
$19.04
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.04
|
| Rate for Payer: InnovAge PACE Commercial |
$28.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.51
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19.04
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: Prime Health Services Medicare |
$20.18
|
| Rate for Payer: Riverside University Health System MISP |
$20.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.43
|
| Rate for Payer: United Healthcare All Other HMO |
$15.43
|
| Rate for Payer: United Healthcare HMO Rider |
$15.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.94
|
| Rate for Payer: Vantage Medical Group Senior |
$19.04
|
|
|
HC FACTOR IX PTC
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
900910029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Central Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
|
|
HC FACTOR V, ACG
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
900910060
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$138.60 |
| Rate for Payer: Adventist Health Commercial |
$30.80
|
| Rate for Payer: Cash Price |
$84.70
|
| Rate for Payer: Central Health Plan Commercial |
$123.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.60
|
| Rate for Payer: EPIC Health Plan Senior |
$61.60
|
| Rate for Payer: Galaxy Health WC |
$130.90
|
| Rate for Payer: Global Benefits Group Commercial |
$92.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$138.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.80
|
| Rate for Payer: Multiplan Commercial |
$115.50
|
| Rate for Payer: Networks By Design Commercial |
$100.10
|
| Rate for Payer: Prime Health Services Commercial |
$130.90
|
|
|
HC FACTOR V, ACG
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
900910060
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$138.60 |
| Rate for Payer: Adventist Health Commercial |
$30.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$93.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.06
|
| Rate for Payer: Blue Shield of California Commercial |
$93.48
|
| Rate for Payer: Blue Shield of California EPN |
$61.14
|
| Rate for Payer: Cash Price |
$84.70
|
| Rate for Payer: Cash Price |
$84.70
|
| Rate for Payer: Central Health Plan Commercial |
$123.20
|
| Rate for Payer: Cigna of CA HMO |
$98.56
|
| Rate for Payer: Cigna of CA PPO |
$113.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.83
|
| Rate for Payer: EPIC Health Plan Senior |
$17.65
|
| Rate for Payer: Galaxy Health WC |
$130.90
|
| Rate for Payer: Global Benefits Group Commercial |
$92.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$138.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.65
|
| Rate for Payer: InnovAge PACE Commercial |
$26.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.65
|
| Rate for Payer: Multiplan Commercial |
$115.50
|
| Rate for Payer: Networks By Design Commercial |
$100.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.65
|
| Rate for Payer: Prime Health Services Commercial |
$130.90
|
| Rate for Payer: Prime Health Services Medicare |
$18.71
|
| Rate for Payer: Riverside University Health System MISP |
$19.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.30
|
| Rate for Payer: United Healthcare All Other HMO |
$14.30
|
| Rate for Payer: United Healthcare HMO Rider |
$14.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.41
|
| Rate for Payer: Vantage Medical Group Senior |
$17.65
|
|
|
HC FACTOR VIII AHG
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900910028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
HC FACTOR VIII AHG
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900910028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.44
|
| Rate for Payer: Blue Shield of California Commercial |
$94.69
|
| Rate for Payer: Blue Shield of California EPN |
$61.93
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.16
|
| Rate for Payer: EPIC Health Plan Senior |
$17.90
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: InnovAge PACE Commercial |
$26.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.90
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Medicare |
$18.97
|
| Rate for Payer: Riverside University Health System MISP |
$19.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
|
HC FACTOR VII, (PROCONVERTIN)
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
900910027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.44
|
| Rate for Payer: Blue Shield of California Commercial |
$94.69
|
| Rate for Payer: Blue Shield of California EPN |
$61.93
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.16
|
| Rate for Payer: EPIC Health Plan Senior |
$17.90
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: InnovAge PACE Commercial |
$26.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.90
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Medicare |
$18.97
|
| Rate for Payer: Riverside University Health System MISP |
$19.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
|
HC FACTOR VII, (PROCONVERTIN)
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
900910027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
HC FACTOR V LEIDEN MUTATION
|
Facility
|
OP
|
$386.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
900912323
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$59.43 |
| Max. Negotiated Rate |
$347.40 |
| Rate for Payer: Adventist Health Commercial |
$77.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$73.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$234.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$293.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.49
|
| Rate for Payer: Blue Shield of California Commercial |
$234.30
|
| Rate for Payer: Blue Shield of California EPN |
$153.24
|
| Rate for Payer: Cash Price |
$212.30
|
| Rate for Payer: Cash Price |
$212.30
|
| Rate for Payer: Central Health Plan Commercial |
$308.80
|
| Rate for Payer: Cigna of CA HMO |
$247.04
|
| Rate for Payer: Cigna of CA PPO |
$285.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.05
|
| Rate for Payer: EPIC Health Plan Senior |
$73.37
|
| Rate for Payer: Galaxy Health WC |
$328.10
|
| Rate for Payer: Global Benefits Group Commercial |
$231.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$347.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$120.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73.37
|
| Rate for Payer: InnovAge PACE Commercial |
$110.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$257.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.32
|
| Rate for Payer: Multiplan Commercial |
$289.50
|
| Rate for Payer: Networks By Design Commercial |
$250.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$73.37
|
| Rate for Payer: Prime Health Services Commercial |
$328.10
|
| Rate for Payer: Prime Health Services Medicare |
$77.77
|
| Rate for Payer: Riverside University Health System MISP |
$80.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$231.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$231.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.43
|
| Rate for Payer: United Healthcare All Other HMO |
$59.43
|
| Rate for Payer: United Healthcare HMO Rider |
$59.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$73.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: Vantage Medical Group Senior |
$73.37
|
|
|
HC FACTOR V LEIDEN MUTATION
|
Facility
|
IP
|
$386.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
900912323
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$77.20 |
| Max. Negotiated Rate |
$347.40 |
| Rate for Payer: Adventist Health Commercial |
$77.20
|
| Rate for Payer: Cash Price |
$212.30
|
| Rate for Payer: Central Health Plan Commercial |
$308.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.40
|
| Rate for Payer: EPIC Health Plan Senior |
$154.40
|
| Rate for Payer: Galaxy Health WC |
$328.10
|
| Rate for Payer: Global Benefits Group Commercial |
$231.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$347.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$257.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$238.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.20
|
| Rate for Payer: Multiplan Commercial |
$289.50
|
| Rate for Payer: Networks By Design Commercial |
$250.90
|
| Rate for Payer: Prime Health Services Commercial |
$328.10
|
|
|
HC FACTOR V LEIDEN MUTATN B INDI
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
900913619
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.43 |
| Max. Negotiated Rate |
$387.90 |
| Rate for Payer: Adventist Health Commercial |
$86.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$73.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$261.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$293.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.49
|
| Rate for Payer: Blue Shield of California Commercial |
$261.62
|
| Rate for Payer: Blue Shield of California EPN |
$171.11
|
| Rate for Payer: Cash Price |
$237.05
|
| Rate for Payer: Cash Price |
$237.05
|
| Rate for Payer: Central Health Plan Commercial |
$344.80
|
| Rate for Payer: Cigna of CA HMO |
$275.84
|
| Rate for Payer: Cigna of CA PPO |
$318.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.05
|
| Rate for Payer: EPIC Health Plan Senior |
$73.37
|
| Rate for Payer: Galaxy Health WC |
$366.35
|
| Rate for Payer: Global Benefits Group Commercial |
$258.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$120.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73.37
|
| Rate for Payer: InnovAge PACE Commercial |
$110.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$287.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.32
|
| Rate for Payer: Multiplan Commercial |
$323.25
|
| Rate for Payer: Networks By Design Commercial |
$280.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$73.37
|
| Rate for Payer: Prime Health Services Commercial |
$366.35
|
| Rate for Payer: Prime Health Services Medicare |
$77.77
|
| Rate for Payer: Riverside University Health System MISP |
$80.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$258.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.43
|
| Rate for Payer: United Healthcare All Other HMO |
$59.43
|
| Rate for Payer: United Healthcare HMO Rider |
$59.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$73.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: Vantage Medical Group Senior |
$73.37
|
|
